Study objective-To identify and quantify the factors responsible for the differences in mortality between affluent and deprived areas, the north and the south, and urban and rural areas in England and Wales.

Design-A multiple Poisson regression analysis of cause specific mortality in the 403 local authority districts, each classified by deprivation (using the Jarman Index), latitude (from 50° to 55° north) and urbanisation, adjusting for age, sex, and proportion of ethnic minorities.

Setting-England and Wales 1992.

Main results-All cause mortality was 15% higher in the districts comprising the most compared with the least deprived tenth of the population, 23% higher in the most northern (55°) than in the most southern (50°) districts, and 4% higher in metropolitan (within large cities) than rural districts.

More than two thirds of the overall excess mortality with deprivation, latitude, and urbanisation was from three diseases-ischaemic heart disease, lung cancer, and chronic bronchitis and emphysema.

The excess mortality from these and other diseases closely matched that predicted from differences according to deprivation and latitude in smoking, heavy alcohol consumption, Helicobacter pylori infection, and temperature, and thus could be attributed to these causes. (...)